Impact of COVID-19 on Cardiovascular Testing in the United States Versus the Rest of the World.
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Hirschfeld Cole B, Shaw Leslee J, Williams Michelle C, Lahey Ryan, Villines Todd C, Dorbala Sharmila, Choi Andrew D, Shah Nishant R, Bluemke David A, Berman Daniel S, Blankstein Ron, Ferencik Maros, Narula Jagat, Winchester David, Malkovskiy Eli, Goebel Benjamin, Randazzo Michael J, Lopez-Mattei Juan, Parwani Purvi, Vitola Joao V, Cerci Rodrigo J, Better Nathan, Raggi Paolo, Lu Bin, Sergienko Vladimir, Sinitsyn Valentin, Kudo Takashi, Nørgaard Bjarne Linde, Maurovich-Horvat Pál, Cohen Yosef A, Pascual Thomas N B, Pynda Yaroslav, Dondi Maurizio, Paez Diana, Einstein Andrew J, INCAPS-COVID Investigators Group
Аннотация
BACKGROUND: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality.
METHODS: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States.
RESULTS: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis.
CONCLUSIONS: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection.